Too fat? The cash-starved NHS might not treat you

Peter Pallot asks whether the Government should take a tougher line on those
who do not look after their health.

The obese are likely to be targeted after Britain's 'succesful' ban on smoking in public placesPhoto: Jack Sullivan / Alamy

9:34AM BST 27 Sep 2010

Even opponents of the Coalition accept that it has been very good at getting across the dire state of Britain’s finances. It has hammered home the message that every one pound in four that it spends has to be borrowed (sotto voce, thanks to Gordon Brown).

A beneficial spin-off seems to be growing awareness that whatever it might say about “ring-fencing” the health service budget, the role of the NHS as an all-enveloping cradle-to-grave service has run its course.

Rising technology costs and a greying, more demanding population have scuppered NHS founder Aneurin Bevan’s vision. The unfortunate - and avoidable - fact that Britain has the highest-paid health professionals in Europe has not helped, either.

Now comes a report suggesting that the public is increasingly realistic about the limitations of state-run healthcare. And that many people think that the Government could, and should, take a tougher line on those who do not look after their health.

The report, Visions of Britain 2020, from consumer trends think-tank Future Foundation and insurer Friends Provident, foresees more official stick being applied to obese backsides. It quotes the “huge success” of the smoking ban as an example of intervention aiding public health.

Backed by opinion polls supporting taxes on high-calorie food, and the belief that the obese may justifiably be pushed down the queue for surgery, the authors foresee a “new Puritanism”.

The Puritans will pressure Government to crack down on overeating and under-exercising, just as anti-tobacco group ASH and road safety campaigners have influenced policy.

The movement is already under way. In 2007, the then Health Secretary, Patricia Hewitt, defended as “perfectly legitimate” the refusal of NHS trusts to provide some treatments to heavy smokers and the obese. At the time, four trusts were refusing joint replacements for those seriously overweight. Miss Hewitt said that trusts were entitled “to get together with their doctors on any area of clinical judgment and say 'these are the guidelines for this kind of treatment’.”

The think-tank report argues that such actions will become more widespread as the public purse comes under more pressure. By 2020, it predicts an end to IVF on the NHS. Within a few days of the report’s release, the medical journal Pulse reported that one in five primary care trusts was telling GPs to cut back on IVF treatment.

The think-tank also foresees an end to subsidised dental care, complementary medicine, and obesity surgery and drugs. The report, based on interviews with leading doctors, opinion polls and other research, even predicts that dementia care will cease to be offered on the NHS.

Much of the NHS budget will be eaten away by type-2 diabetes, a classic “lifestyle disease”. Eating too much and not exercising are the main cause for the 2.3million sufferers in Britain. Treatment already swallows 10 per cent of the budget. The number of patients with it is predicted by the charity Diabetes UK to top four million by 2025.

Dr Sarah Brewer, a GP consulted for the report, said: “There will be less money from the state to help people maintain their health, so something needs to give, and increasingly it will be up to us to take responsibility for our own health.

“In addition, there will be endless paring away in subtle degrees at the funding of all sorts of treatments. The changes will be profound.”

On the bright side, the report showed public awareness of the problems. In a poll, 76 per cent said that they were responsible for their own health. Almost half supported the idea of a “fat tax” on unhealthy foods, and more than a third said that the NHS should not prioritise people who don’t look after their health. Among the young, 58 per cent thought healthy behaviour should be rewarded.

As its title makes clear, the report centres on the UK. But escalating health costs, awkward demographics and budget restraints apply across most advanced economies.

In America, the Food and Drug Administration (FDA) is considering revoking approval for the same drug in advanced breast cancer. Clearly, the US is no better placed to pay for expensive drugs that marginally extend life. The question arises: would the FDA be considering a U-turn on a drug it had previously approved if President Obama were not about to launch a public health scheme which will hit taxpayers?

It chimes with the Future Foundation line that you can no longer expect someone else to pick up your bill for healthcare.